Talking mental health in Sikkim - The Care Project
The Care Project is a platform that seeks to address mental health literacy in the state. Our objective is to build a robust network of mental health literacy, accessibility to mental health care and to introduce a sustainable mental health curriculum in Sikkim
The recent news about a 27-year-old woman’s death by suicide at Upper Burtuk is heartbreaking. The victim had a medical history wherein she suffered from mental illness along with epilepsy. She is not a one-off victim and she again brings to limelight the link between mental health and suicide in Sikkim. According to the latest report by the Government of India, Sikkim has earned the sad distinction of having the largest number of suicide cases in the country.
Here it is worth mentioning that the state has done a lot to create awareness in the state as a suicide prevention measure. However, what is equally important is to identify and address the causes of suicide.
Most suicide cases are related to psychiatric problems, with depression, substance use disorders and psychosis being the most relevant risk factors. This effectively encourages us to understand suicide as the final tier in a hierarchy where mental health occupies the first, a lesson one observes in the case of the 27-year-old woman mentioned above.
Building on this, a study conducted by Dr Sachdeva & Thapa (2017) - “ Suicide in Sikkim: A socio-psycho assessment”- uses suicide notes to establish that most of the causative factors of suicide rest on social structures. It states, “The incidence of suicide is highest among those who are ‘illiterate’ and fall under the category of the lower-income group in urban areas.”
This brings us to the conclusion that mental health could also be related to social justice issues. Identity-based discrimination, lack of employment and education may contribute to poor mental health, which, if not recognised and treated at the onset, can lead to mental illness, in some cases. To underline our emphasis, in order to address the prevention of suicide - we should aim to destigmatise and prioritise mental health in Sikkim while addressing other sociological factors that may have bearings on one’s mental health.
The State of Mental Health in Sikkim
According to a report by the World Health Organisation, India is ranked as the most depressed country in the world with a dismal proportion of mental health professionals. The National Crime Records Bureau 2015 reported that the entire mental health workforce, comprising clinical psychiatrists, psychologists, psychiatric social workers and psychiatric nurses, stand at 7,000, while the actual requirement is around 55,000.
The obvious undertone to this figure is that mental health professionals are not proportionally divided among different states in the country. Sikkim is one such state which might fall under the category of having a limited number of mental health professionals for care.
Satish Rasaily, MD Psychiatry, Officer (OST), Singtam District Hospital, noted in his publication from 2015 that ‘there are only 6 psychiatrists in Govt Sector (Sikkim) and most of them are serving in State Hospital & 3 District Hospitals’. This figure, while being extremely disappointing can point to two leading situations that express the reflection of this shortage in numbers:
The Stigma of Mental Health in Sikkim
The underlining understanding of mental health illness in the state is often associated with words like, ‘Pagla’ (crazy), ‘laata/laatis’ (dumb) more often or so to mean a homeless person. This almost draws an understanding that mental illness can only happen to economically-disadvantaged sections which nurture a huge form of stigma.
Overarching statements like, “Aaajkal ko naani harule kei jhelnu sakdaina.” (kids these kids cannot handle themselves) or “Depression bhanne kehi hundaina, sabbai man ko khela ho” (There is nothing like depression, it’s all in the head’) are far too common in our households. Such statements bring deep shame and embarrassment to identify mental health challenges to seek help, especially because poor mental health or mental illness is associated with a lack of one’s willpower, dishonour to the family and socio-economic standing.
This is further exacerbated by existing cultural norms that question men’s masculinity for trying to recognise their emotional wellbeing, for example, “Keta bhaera k esto emotional bhai baseko/keti jasto na ruta.” (You are a boy. Why are you being emotional? Don’t cry like a girl)
This stigma needs to be addressed because of the following reasons:
● It helps in suicide prevention
● Timely intervention and support to prevent worsening of one’s mental health illness
● Normalises community care and support for those in need
● Addressing substance abuse
Satish Rasaily in his publication noted that the suicide rate in Sikkim has increased exponentially in the last 10 years ranging 29 to 45 per 1 lakh population, much higher than the national average of 11 per 1 lakh population, which apart from being alarming also notes the degree of mental health challenges prevalent in the state. Moreover, the problem of substance abuse is well noted in the state, and there is enough research available that establishes a strong connection between mental illness and substance abuse.
Lack of Mental Health Literacy
Stigma and discrimination against people with mental illness arise due to a lack of mental health literacy. It is important for the language of mental health to be accessible in Sikkim just as it is important in other parts of the country because it helps people
a) recognise the early onset of mental disorders
b) understand the stressors behind their poor mental health and
c) seek help when needed.
One of the respondents from our survey noted that: “In retrospect, I realise I have had anxiety since I was 10 years old, but because I could not identify those experiences as ‘anxiety’, I could not seek help and it grew worse as a disorder. I could only understand my ‘anxiety’ issues when I moved to Delhi for my higher education.”
Everyone has mental health and anyone can be diagnosed with a mental illness irrespective of class, caste, religion, gender, sexuality, disability – although, the impact of one’s identity(s) or identity-based discrimination can make them more vulnerable to mental illness and mental health challenges. Mental health literacy helps us understand such intersections and also encourages us to see it as a structural and social problem.
There is a huge vacuum for mental health awareness in Sikkim and while there have been concerted efforts made by the government and civil society organisations, a lot more work is needed to realize accessibility and affordability of mental health care and mental health literature for all.
The Role of Care Project and the Announcement of our Survey
The Care Project is a platform that seeks to address mental health literacy in the state. Our objective is to build a robust network of mental health literacy, accessibility to mental health care and to introduce a sustainable mental health curriculum in Sikkim.
We are in the process of carrying out a survey to assess the rate of mental health literacy in Sikkim and to understand specific mental health needs owing to the unique socio-cultural settings of the state. We would appreciate it if you could spare some time to fill this form and share the same. Please feel free to reach out to us for any queries/suggestions on the same at firstname.lastname@example.org
Via The Care Project
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